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� <br /> APPLICATICr"] FOR CONSTRUCT"�N PERMIT ��� <br /> TO BE COMPLETEf�IN BLACK INK—PLEASE PRINT <br /> HEATING S�STEM: ❑GAS ❑ELECTRIC 0 ] <br /> BUIL�ING DEPF�AT'AAENT <br /> 259-b310 <br /> ! I DEMOLITION � I COMBINA�i�N I ! B'JILDING i�MECHANICAL 17 PLUMBING i=; SIGN <br /> OWNER MAILADDi�E55 r�-- LITY ZIP PHONc <br /> �.Z%"�P �e�•el,D� �s� `�lca ) !?dzD.-, s(� �e�'�r,'/ l,.�e Y&e 2< </�3S- �/-T�/�/ <br /> TENANT MP.ILAD�RESS � CITY ZIP PHONE <br /> AflCHITE/CTORDESIfiNER MRILAODRESS CITI' ZIP PMONE <br /> ��1`�-�iDM ��/i� � �2/uo> �17�'O�.�r' gr�c. 4�'0 2 < <ls3s— �/�y�/ . <br /> GENCflALC ACT R MLADDRESS CITY TP PHONE STATELICENSEN <br /> L cu-+D Co.,J7�iv�tlC.'o-, �cr�o o?/uo 7 U7�Gr•S�' f�oJ[� ; `1`/10 �/ �/13s-�/.PN�/ LG"'l7COCic�/S�1kAl <br /> MECHANICQCONTRRCTOR MAILADDHE55� CIN ZIP PHONE STATEUCENSet <br /> �SSdG�a �Frr:� �1 • <br /> f PlUMBINGCONTMCTOR MAILADDRESS CIN ZIP PHONE STATELICEP�SER <br /> Fr��4�.,�, �'L��, ', -- — <br /> _cu_�PF WOflK � <br /> . t�1'NEV! � ! ADDITION Ll ALTERATION Cl REPA�R I_i DEMOLITION L.l WOODSTOVEIFRPLINSERT Cl BUIL�jINGRELOC��TION <br /> C/ON�TACT PEfISON AND PHONE N0. / / r /, <br /> t CONTMCTPflICEOFWOflK CT�� � �I/1 �40 " L'D�J — y.J�7 <br /> DESLRIBEWORKANDSOUAREFWTAGEI�`/�fl. �Y C <br /> p„�c�� N�� a���, <br /> PflOPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> . �'�^ N� CqM 2u ��� '��e APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT.ALL <br /> � LE�SCflIPTIONOFPf70PERT��SHOWNBELOWORAZA!':�FW/1flCOPIES) PROVISIONSOFLAWSANDORD�NANCESGOVEANINGTHISTYPEOF <br /> ` �or�� e�wK oF _�D�✓c�c� WORK WILL BE COMPLETED WITH WHETHER SPEGFIEO HEREIN OR <br /> � � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � Iv)G/� La.�E� 1 �U . AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � T OTHFR STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONS'i RUCTIO�:.THAT I AM AUTHORIZEO BY THE <br /> UWNER OF THIS PROPERTY TO PERFORM THE WC�liK FOR WHICH <br /> I APPLICATION IS MADE AND 1 CC!ApLY LVITH THE STATE <br /> � /C n/�J CONTRACTORS LAW 1827 RCW AND 2962W WAC. <br /> � c! O <br /> � �" �oa� -000 -os/ .. X d��C' C�I�-s`/�� s <br /> . '� PR0.IECTADDPE55 q \I 5icruTunE D�TE /� <br /> �� O'� � V'C V_ CIiVBUS'NESSUCENSENO. <br /> . PLOMBING MECMANICAL <br /> '� NO. TYPE OF FIXTURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> � �� WATER CLOSET(TOILET) � A/C—A/HPlCLG UNITS—H.P. � <br /> �� �. BATHTUB ; � FOFCED AIR SYSTEMS—B.T.U./d�M E.A. ' <br /> S"" LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M _T_ <br /> � SHOWEP _ ' f CLOTHES DRYERS � <br /> KITCHEN SIVK 8 DISP ; I VENTILATION FAN �_ <br /> � DISHWASHER � RANGE HOOD � <br /> � L'1UNDRYTRAY ; WAI�ERHEATER ' <br /> CI.OTHES WASHER i WOOD STOVE i <br /> . URNAL ' ► METAL F�REPLACE 8 CHIMNEY .3('' — <br /> '� DP.INKING FOUNTAIN � FIREPLACE INSERT � <br /> �� FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> � ROOF DRAINS—RAINLEADEFS � ,rj EXHAUST FAN � <br /> � SINK(SERVICE—BAR,ETC.) i ; � <br /> ' �J <br /> , <br /> �. , =, , <br /> � <br /> , <br /> , , � <br /> ' SUBTOTAL $ ; SUBTOTAL $ ' <br /> PERMIT $ � PtRMIT $ � <br /> ', TOTAL FEE $ ' TOTAL FEE $ ' <br /> � FOR OFFICE USE ONLY: <br /> � FPONTSETBACK � REARSETBACK /p � SIDESETBAC� PUNCHECKNUMBER FEE R EIPTNO. - <br /> 25 �v� 7.S �°�:3/ 30 l�95� <br /> use IOTANEA ' V1,CnyTsire FEES VALUATION FEE <br /> �� / y EUILDING - � � ,j <br /> i <br /> TVPEO COMS.ALLOWABLE 7YPEOFt NST.ACTURL occuvu�cr No.orv+nwxGuxrts � <br /> � � � .tJ ^ �� / PLLiNBING - D—.>� �Od <br /> _—�� �y� <br /> SQEOFBLUI;. NO.OfSTOflIES BASEMENT MECHI\NICAL �D � //�/ <br /> 2-s9e sf� � Z �l� � <br /> ' OCCUPAN!:Y LOAD FIRE SPRNKLERS NEO'D HEIGHT LIMITATION ADD:fIONAL PLAN CHECK i <br /> � i <br /> A NV SPF� KLE�� � <br /> RERSON FOR SPRINKLERS i <br /> SfATE BUILDING SURCHARGE �SCJ <br /> i <br /> �� INiAKE Pl' PLANS APQ�VED BV CITY OF EVERETT PI�BLIC WORKS ' U i �D <br /> V LOCAL SALES � <br /> Z/ 93 TAX CODE IS 3105 TOTAL �oaa �OD <br />